Feature

APA and the APA Practice Organization (APAPO) believe the national debate on health-care reform should be about much more than covering the uninsured. The overarching goal is to transform the very way that health care is delivered in this country.

"The main message we're trying to get across is that mental and behavioral health are integral to overall health," says APA Chief Executive Officer Norman B. Anderson, PhD, pointing out that the leading causes of death in the United States are behavioral-related. "Psychology, as the science of behavior, has much to contribute to improving the health status of our nation and a vital role to play in health-care reform."

Building on principles adopted by the APA Council of Representatives in 2007 (see "Psychology's role in health-care reform" in the February Monitor), APA senior policy advisor Ellen Garrison, PhD, recently coordinated an APA and APAPO staff effort to develop a list of eight priorities for health-care reform. In the months to come, members and staff from APA and APAPO will seek to educate policymakers about the following priorities:

• Integrating mental and behavioral health care into primary care and other health-care services across the lifespan, with psychologists recognized as vital members of interdisciplinary health-care teams. Increasingly, primary-care physicians rely on the unique mental and behavioral health services that psychologists provide to patients in a variety of primary care settings. Psychologists often take a lead role on multidisciplinary treatment teams when a patient has a primary mental health or substance abuse diagnosis. The Veterans Health Administration already uses a model of integrated care that has proven very effective.

• Ensuring access to quality mental and behavioral health promotion, screening and referral, prevention, early intervention and wellness services, with particular attention to at-risk populations. APA and APAPO are working to ensure that members of Congress recognize psychology's important role in preventing chronic illness, not just treating it, and in promoting wellness. APAPO is advocating for full inclusion of practicing psychologists and psychological services in a reformed health services delivery system. "We want Congress to recognize that psychology is vital to disease prevention, treatment and wellness," says Marilyn Richmond, JD, assistant executive director of government relations for APAPO.

• Developing and maintaining a diverse psychology work force that is competent to develop and apply evidence-based behavioral and psychosocial assessments and interventions to address the current needs and changing demographics of our nation's population. APA's Education Directorate has already made significant progress in this area, says Nina G. Levitt, PsyD, APA's associate executive director of education government relations. The directorate successfully pushed for the establishment of the Graduate Psychology Education (GPE) Program in 2002 (read more about this program on page 60) and the Center for Deployment Psychology (CDP) in 2006, both of which are designed to provide federal funding for psychology training. The GPE Program, which trains psychology graduate students to specialize in underserved populations, needs a substantial increase in funding to reinstate its geropsychology training grants, to begin a focus on returning military personnel and to restore funding to the general grants. The CDP Program, which trains psychologists in post-traumatic stress disorder, traumatic brain injury and other trauma-related problems, was incorporated into the Department of Defense Center of Excellence and will be funded indefinitely.

• Ensuring that quality mental and behavioral health care and access to psychologist providers are included in benefit plans. Instead of creating a single-payer, government-run system, the Obama administration seeks in health-care reform to build on the current system of private insurance and include a national insurance pool so small businesses and self-employed individuals can purchase health insurance coverage. Among its advocacy efforts, APAPO will seek the inclusion of comprehensive mental health and substance use services at parity with physical health services in every benefit package created through the insurance pool.

• Eliminating disparities in mental health status and mental health care through the use of psychological and behavioral research and culturally and linguistically competent services. APA's Minority Fellowship Program has trained more than 1,000 psychologists over the last three decades. "But there's so much more that needs to be done," emphasizes Annie Toro, JD, associate executive director of APA's government relations for public interest, pointing to the ever-increasing diversity of the U.S. population. In addition to support for training, APA is calling for more research on the incidence of mental health disorders across race and ethnicity, how various populations view these disorders and possible treatments, and the comparative effectiveness of treatments across ethnic and minority populations.

• Increasing federal funding for basic and translational psychological and behavioral research and training to develop and evaluate empirically based treatments to improve health care. APA's Science Directorate is already making great progress in this area, says Garrison. The economic stimulus bill, for instance, contained what assistant executive director for science government relations Geoff Mumford, PhD, calls "the largest single infusion of research funding in the history of the National Institutes of Health."

• Including strong privacy and security records protection in the development of health information technology, with special attention to mental health records. "The APA Practice Organization already has a big victory," says Richmond. The Health Information Technology for Economic and Clinical Health Act, part of the stimulus package that became law in February, includes strong records protections sought by APAPO.

• Enhancing the involvement of psychologists and other health-care professionals with consumers, families and caregivers in planning, implementing and evaluating health-care initiatives. "Given that much of psychotherapy's effectiveness stems from the relationship between the therapist and client, consumer involvement throughout the treatment process is critically important," says Garrison. Health-care reform should also assist family caregivers through the provision of supportive mental health services and respite care.


Rebecca A. Clay is a writer in Washington, D.C.